REGISTRATION FORM
Session*:
Mode of Admission*:
Type of Admission*:
Category:
Lateral*:
Course*:
Priority(1st):
Priority(2nd):
Priority(3rd):
Student Name(As per 10th Marksheet)*:
Father's Name(As per 10th Marksheet)*:
Student Mobile No.*:
Aadhar Card No.*:
EMail Id.*:
Personal Detail
Student Name(First Name):
Middle Name:
Last Name:
Student Name(In Hindi):
Mother's Name(As per 10th Marksheet):
Address for Correspondence:
Pincode:
  Is Permanent Address same as Address for communication:
Permanent Address:
Pincode:
State:
District/City:
Post-Office:
Tehsil/Village:
Country:
Landline No.:
Domicile:
Father Mobile No.:
Alternate Contact No.:
EMail Id.:
Aadhar No.:
Mother Mobile No.:
Alternate Contact No.:
EMail Id.:
Aadhar No.:
Father's Occupation:
Designation:
Qualification:
Mother's Occupation:
Designation:
Qualification:
Father Annual Income:
Mother Annual Income:
Date of Birth:
Blood Group:
PAN Card No.:
Nationality:
Gender:
Religion:
Minority:
Apply for Scholarship:
KM:
EX-S:
PH:
FF:
AF:
KM: Kashmiri Migrants, EX-S: Ex-Serviceman, PH: Physically Handicapped, FF: Freedom Fighter; AF: Armed Forces
Academic Detail
10th Result
Roll No.:
School Name:
Board Name:
Medium:
Passing State:
Passing Year:
Marks Obtained:
Maximum Marks:
(%age)/CGPA:
Division:
12th Result
Roll No.:
School Name:
Board Name:
Medium:
Passing State:
Passing Year:
Marks Obtained:
Maximum Marks:
(%age):
Division:
Physics:
/
Math.:
/
Chemistry/Biotech/Biology/IP:
/
PCM(%age):
English:
/
Computer:
/
Diploma Holder(Lateral Entry)
Roll No.:
School/College Name:
Board/University Name:
Medium:
Passing State:
Passing Year:
Marks Obtained:
Maximum Marks:
(%age)/CGPA:
Division:
Entrance Detail
JEE Main:
Roll No.:
JEE Rank:
Category Rank:
Score/Percentile:
GATE:
Roll No.:
GATE Rank:
Category Rank:
Score/Percentile:
Other:
Roll No.:
Other Rank:
Category Rank:
Score/Percentile:
Other Detail
Sibling Studied/Studying from IPEC:   
Passing Year:        
Reference of IPEC:
                   
Photograph:    

Student photograph must be png/jpg/jpeg file format. Also, maximum file size must be less than 50kb.